Selective radio-guided neck dissection for cervical lymph node metastasis from occult thyroid cancer

Background: Cervical lymph node metastases are rarely observed as a fi rst manifestation of occult thyroid carcinoma.
Case Report: The case of a 35-year-old woman is presented. Five years before she had undergone near-total thyroidectomy because of multinodular goiter, which proved to be a benign colloid goiter at histology. Neck ultrasonography (USG) revealed fi ndings suspicious of neoplastic/metastatic adenopathy. Fine-needle aspiration (FNA) cytology was inadequate, but thyroglobulin was detected in the needle washout, revealing metastasis from an occult thyroid cancer. The patient underwent radioguided selective neck dissection followed by radioiodine therapy. After a 5-year follow-up, the patient is free of disease.
Conclusions: In patients with lateral cervical mass, the diagnosis of lymph node metastasis from occult thyroid carcinoma should be considered. USG-guided FNA and thyroglobulin analysis of needle washout are effective and effi cient in the diagnosis and surveillance in these patients. Radio-guided surgery may represent an alternative technique with low morbidity.

Keywords: occult papillary thyroid carcinoma, lymph node metastasis, Fine-needle aspiration cytology, thyroglobulin measurement on needle washout, radio-guided surgery